GPs in England have voted to re-enter dispute with the Government from 1 October, the BMA has announced.
The dispute centres around the contract changes set to begin 1 October which will mean GP surgeries have to keep their online systems, telephones and doors open through the core hours of 8am to 6.30pm.
At a recent special representative meeting of the BMA, Health and Social Care Secretary Wes Streeting told the meeting that GPs that oppose these changes to their contract are ‘laggards’ and they need to “get with the 21st century.”
The BMA is also seeking legal advice on the legality of opening up online requests throughout core hours without safeguards, it said.
GPs are concerned over how the changes will affect patient safety and reduce GPs time to see patients as the promised ‘safeguards’ have not been put in place and the contract changes are different from those the GPs signed up to in February this year.
Streeting’s comments were made whilst being questioned by BMA Chair Dr Tom Dolphin at the BMA’s special representative meeting on the government’s 10-year NHS plan held 14 September and were aimed at GPs who oppose the access changes based on non-IT technical grounds.
Contract changes to increase access to GP surgeries were agreed in February this year, but at the time GPs were told only online consultation tools would be required to stay open continually through the core hours of 8am to 6.30pm – and this method of communication would only be used for appointment requests, medication queries and admin requests.
The BMA accepted the contract changes on the assurance that they would be supported by ‘necessary safeguards’ to ensure urgent queries were not submitted by mistake via the online systems.
However in August the contract variation notice was published and it went significantly further than expected, as well as on-line communication being open during core hours, full in-person and telephone access would be required during these hours.
A new GP patient charter reinforces this and explains that practices will be expected to inform patients within one working day about what will happen next when they contact the surgery. Automated messages or blanket diverts to other services without ‘active triage’ would not cover what is expected of practices, according to NHS England.
In the BMA session Streeting said that these changes are achievable and unavoidable but that ‘some GPs’ just don’t ‘like’ them.
Pulse has reported that NHS England considers there was no difference between the substance of what practices were told in February and the amendment of the wording to the contract, and that the updated wording was merely to emphasise the obligation to remain open during core hours.
GPs concerns, which were outlined in a motion that was passed at the BMA’s special representative meeting, include that unlimited patient online demand will jeopardise and lead to burnout for all medical staff not just GPs; and that the problem of patients presenting online with symptoms that could be urgent rather than routine means that the safest option for GPs is to assume that all online consultation requests are urgent until they are triaged by a senior responsible clinician.
The access changes make it impossible for GPs to limit their workload and as a result GPs will be diverted to sorting requests rather than seeing patients, with the possibility of waiting lists to see GPs. As the BMA notes in a statement on the dispute:
‘Online systems cannot distinguish between non-urgent and urgent patient queries and GPs fear this could lead to potentially serious problems being missed when the important ‘needles’ get lost inside the huge haystack of unmet patient need.’
The access changes are also a concern for non-medical staff, as has been highlighted by the Institute of General Practice Management (IGPM), who warned that active triage will effectively become a contractual requirement, but ‘without adequate funding or workforce support’.
‘General practice teams are already working under immense pressure. Without additional investment in clinical and administrative capacity, the expectation to deliver these standards risks undermining both patient safety and staff wellbeing,’ the IGPM said.
Prior to the BMA meeting, several local medical committees urged the BMA to enter a contract dispute with the Government over the issue.
Following their annual general meeting, the combined West Midlands LMCs together with Berkshire, Buckinghamshire and Oxfordshire LMCs, have called for the GPC to launch a contract dispute over the changes unless they are amended.
In a letter to chair of the GPCE, Dr Katie Bramall, the LMCs noted that ‘practices will have to see unsafe volumes of patients or have no option to breach their contracts.’ It requests that the GPC ‘urgently consult with the Government,’ to re-negotiate the access requirements with safeguards built in.
If this isn’t possible, the letter requested a ‘template letter from the BMA for each practice stating that for safety reasons they will need to breach their contract as of 1 October 2025. Practices must be allowed to signpost patients to other local, urgent, and emergency services, without the threat of contract or performance management.’
BBO LMCs chief executive Dr Matt Mayer told Pulse that the contract change of online consultations being available throughout core hours ‘was sold to the profession on the condition that it would only be for routine administrative queries’, and would only be implemented if ‘necessary safeguards’ had been developed to ensure no urgent requests can be erroneously submitted.
When Streeting was asked by Dr Dolphin, in the BMA meeting, whether he could agree to speak to the GPC to try and avert a dispute on this? Mr Streeting said he was “happy to talk to GPC about it” but added that the changes had been agreed some time ago and that they were good changes.
In a statement on the dispute from the BMA, GPCE chair Dr Katie Bramall, points out, none of this need happen and patients need not be put at risk:
‘We know that the public’s number one NHS priority is general practice, so it’s disappointing to see the Government being prepared to risk patient safety, practice workforce wellbeing and GP retention, when solving this would not cost a single penny.’
Adding that ‘all is not lost – we still have time in the coming days for the Government to meet us halfway. We will explore all options, but I’m sure our patients and the profession would rather we find a resolution in the coming days. We want to work with the Government in delivering an NHS that we know is safe.’
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